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Psychiatry > Alcohol + Substance Misuse > Flashcards

Alcohol + Substance Misuse Flashcards

1
Q

List the different types of ‘disorders/states’ seen in substance misuse (6) (THAWDD)

A 
Acute intoxication
Harmful use
Tolerance
Dependance syndrome
Withdrawal state
Drug-induced psychosis
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2
Q

What are the core features of Dependance syndrome

A

Primacy (most important thing + relationships etc suffered)
Tolerance
Withdrawal
Rapid reinstated dependance after abstinence
Continued use despite -ve consequences
Loss of control
Narrowing of repertoire (range → one + same setting)

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3
Q

What % of: drink daily?

a) 16-25yrs
b) 25-45yrs
c) 65+ yrs

What % of men + women are alcohol-dependant in UK?

A

a) 1%
b) 4%
c) 13%

Men: 9%
Women: 4%

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4
Q

What proportion hosp admissions related to alcohol?
What proportion violent incidents in pub/club
What proportion RTAs from drinking?

A

2/3rd hosp admissions related to alc

1/5 violence in pubs/clubs
1/6 RTAs from drink driving

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5
Q

What are the Bio (2) - Psycho (1) - Social (5) RFs for Alcohol Misuse Disorder?

A 
Bio: 
Genetic role (alc metab)
1st degree = 7x risk (even if adopted)

Psycho:
Any mental illness
(Stress / Social Anxiety / Low-Self Esteem associated)

Social:
Men
Low socio-economic class
Loss of spouse
Social isolation
Certain professions
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6
Q

List the neurological complications with alcohol misuse (7)

A 
Cognitive/memory impairment
Cerebellar dysfunc
Reduced brain wt/vol
Wernicke-Korkasoff
Central pontine myelinolysis (quadriparesis)

Peripheral neuropathy/myopathy
Optic nn atrophy

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7
Q

List the Resp (2) + CV (4) complications with alcohol misuse

A

Infection susceptibility
Aspiration susceptibility

Alcoholic cardiomyopathy
Arrhythmias (esp AF)
CVA (esp haemorrhagic)
HTN

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8
Q

List the Hepatic complications of alcohol misuse (4)

A

Fatty liver changes in 90% (can occur after 1 binge - reversible w. abstinence)

Alcoholic hepatitis
Cirrhosis as end-stage (fast progress if female/HepBC)
Hepatocellular Carcinoma

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9
Q

List the Renal (2), Pancreas (2) + Spleen (1) complications of alcohol misuse

A

Renal:
Cirrhosis → hepato-renal syndrome
HTN → CKD

Pancreas: Acute/Chronic Pancreatitis

Spleen: Splenomegaly from cirrhosis/portal HT

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10
Q

What are the GI complications of alcohol misuse (3:3:3)

A

Oesophageal: M-W tears / Varices / Barretts

Gastric: Gastritis / Ulcers / Carcinoma

Intestinal: Malabsorp / Chronic diarrh / Colorectal cancer

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11
Q

What are the reproductive complications of alcohol misuse (3F/2M)

A

Female: Sexual dysfunc / subfertility / pregnancy risks
Male: Erectile dysfunc / hypogonadism

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12
Q

List some psychiatric complications of alcohol misuse (6)

A

Substance-induced psychosis (rare/reversible)
Alcohol-Related Brain Damage
Pathological jealousy (monosymp delusion)

Anxiety/Depression (self-medicate / depressant / withdrawal-anxiety)

Scz: associated incidence
Higher risk of: relapse / non-concordance / violence

Suicide: higher risk, esp if: social isolated / many failed abstinence attempts / psych co-morb

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13
Q

What are the social complications of Alcohol Misuse (6)

A

Marital disharmony/divorce
Psychological harm to family
Physical harm /domestic violence

Risky sexual activity
Impact on employment
Financial/legal problems

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14
Q

What are the RFs for more severe alcohol withdrawal (5)

A

Amount alc consumed**
Length time been heavy drinking**

Previous withdrawal
Advanced liver disease
Intercurrent medical illness

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15
Q

In what timeframe does mild/uncomplicated AWS (alc withdrawal syndrome) occur?

A

4-12hrs after

Last 2-5d

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16
Q

What are the symptoms of Mild/Uncomplication AWS (I CANT SIPP)

A

Intense alc craving

Coarse tremor
Anxiety
N+V
Tachycardia

Sweating
Insomnia
Psychomotor agitation
Poss transient hallucinations

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17
Q

In what timeframe do alc withdrawal seizures occur?

What is their incidence?

A

6-48hrs after

5-15% get grand-mal seizures

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18
Q

What are the RFs for withdrawal seizures in alc misuse? (4)(HHIP)

A

H/o head injury
Heavy/prolonged alc consumption
Idiopathic epilepsy
Previous withdrawal seizures

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19
Q

In what timeframe do delirium tremens occur?

What incidence ?

A

1-7d after

5% AWS

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20
Q

List a DDx for delirium tremens (3)

A

Head injury
Encephalopathy (Hepatic/Wernicke)
Alternative cause of delirium

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21
Q

What are the Sx of delirium tremens (8)

A

In addition to Uncomplicated AWS Sx:

Disorientation
Altered consciousness
Amnesia
Hallucinations
Severe psychomotor agitation / tremor
Autonomic disturbance
Fever
Electrolyte imbalance
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22
Q

What are the key components for alcohol detox Tx (3)

A

Symptomatic relief with BZDs (reducing regime w. chlordiazepoxide)
Nutritional/vitamine supplementation (thiamine + multivit)
Close monitoring of complications

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23
Q

Describe the pathophysiology behind Wernicke’s encephalopathy

A

Neurodegeneration from thiamine defc

Haemorrhages + secondary gliosis in grey matter (periventricular/periaqueductal)

24
Q

List the causes of thiamine defc (4)

A

Chronic alc misuse***
Anorexia nervosa
Post-GI surgery
Hyperemesis gravidarum

25
Q

Why are alcoholics particularly prone to thiamine defc? (3)

A
  1. Poor diet
  2. Reduced GI absorption
  3. Reduced hepatic storage capacity (co-existing disease)
26
Q

What is the classic triad of Sx in Wernicke’s encephalopathy (AAO)

+ any other associated Sx (3) (PRN)

A

Acute confusional state (80%)
Ataxic gait
Oculomotor (nystagmus/ophthalmoplegia)

Peripheral neuropathy
Resting tachycardia
Nutritional defc stigmata

27
Q

What is the prognosis like in Wernicke’s encephalopathy (mortality / progression)

A

15% mortality if untreated

80% progress to Korsakoff syndrome

28
Q

How is Wernicke’s encephalopathy managed? (2)

What should not be done / caution when treating?

A

IV High potency thiamine (VitB1) replacement (Pabrinex)
Treat co-existing AWS

NB do not rehydrate with glucose solution before thiamine as will exacerbate

29
Q

What are some causes for Korsakoff syndrome (4)

A

Thiamine defc
Head injury
Encephalitis
CO poisoning

30
Q

What are the clinical features of Korsakoff syndrome (4)

A 
Anterograde amnesia (marked)
Retrograde amnesia (slight)
Confabulation (false memories where amnesic)
Apathy
31
Q

Describe the bio-psycho-social management of Korsakoff syndrome

A

Bio: treat any Wernicke’s / oral thiamine + multivit (2yrs)
Psychosocial: e.g. OT input, carer support (for cognitive impairment)

32
Q

What is the prognosis like in Korsakoff syndrome?

A

50% no recovery
25% signif recovery over time
25% complete recovery

33
Q

List the main headings in taking an Alcohol History

ALC Stops The Pain

A

Screening (CAGE)

Attempts stopping
Lifetime pattern of alc consumption
Current alc consumption

Social/occupational probs
Tolerance/Dependance/Withdrawl
Physical/Mental health

34
Q

What may be seen physically O/E in an alcoholic?

A 
Poor general condition
AWS symptoms
Facial capillarisation
Liver disease stigmata
Peripheral neuropathy
Cerebellar signs
35
Q

What Ix can be done when assessing alcohol misuse? (3)

A

MCV - high specificity (stays high 3-6m post-abstinence)
GGT - more specific < other LFTs
Liver USS

36
Q

What is the MOA of heroin?

A

Crosses BBB → mu agonist → inhibs GABA release
→ less inhib effect / increased release dopamine
→ continued activation of dopaminergic reward pathway

37
Q

What are the harmful effects of heroin via all routes (4)

A

Constipation
N+V
Resp depression
Loss of consciousness/aspiration risk

38
Q

What are the harmful effects of heroin via IV route? (6)

A 
Local abscess
Cellulitis
Osteomyelitis
Bacterial endocarditis
Septicaemia
HIV/HepBC transmission
39
Q

What are the acute (5) + chronic (2) harmful effects of MDMA use?

A 
Hyperthermia
Blurred vision 
Jaw clenching
Nausea
Comedown (fatigue/depression) 12-48hrs after
Depression/Anxiety
Tolerance develops (but not dependance)
40
Q

What is the MOA of cocaine?

A

Blocks monoamine reuptake (Dopa/NA/5HT)

Increased dopamine in mesocorticolimbic

41
Q

What are the acute (3) + chronic (4) harmful effects of Cocaine use?

A

Acute - CV:
Panic attacks
Tachycardia
HTN / Generalised vasocon (MI/CVA)

Chronic:
Septum/sinus necrosis
CKD 2o to HTN
Pregnancy risks (miscarry/abruption)
Psych: panic disorder / GAD / psychosis
42
Q

What are the withdrawal symptoms with Cocaine? (4)

A

Craving
Fatigue / diff conc
Anxiety / dysphoria
Muscle aches / tremors

43
Q

What is the MOA of cannabis?

A

THC activates CB1 (cannabinoid) receptors

→ assoc w. memory/conc/time perception/exec func

44
Q

What are the physical effects of cannabis (4)

A

Increased HR
Increased appetite
Dizziness
Smoking-related pathology

45
Q

What are the psychological effects of cannabis (3)

A

Can provoke panic attacks
Can provoke psychotic Sx
Chronic use → dysthymia, anxiety, avolition

46
Q

What is the MOA of BZDs?

A

Potentiate effects of GABA

47
Q

What are the acute effects of BZDs (7)

A 
Intoxication
Drowsiness
Dizziness/blurred vision
Impaired conc
Impaired coord
Hypotension (if IV)
Resp dep (if IV)
48
Q

What are the chronic effects of BZDs (MDT)

A

Memory/conc impaired
Depression
Tolerance/dependance if regular use for 3-6wks

49
Q

What are the withdrawal Sx seen with BZDs (6)

A

Agitation
Anxiety
Insomnia

Seizures
Delirium
Psychosis

50
Q

Give some examples of harm reduction strategies in alc/drug misuse (3)

A

Don’t share / use uncleaned injecting equipment
Use other methods (i.e. not injecting)
Substitute prescribing (methadone)

51
Q

What are some +ve prognostic factors in giving up alc/illicit drug use (5)

A

Motivated to change

Supportive fam/relationships
In employment

Drug/alc services

Treatable co-morbid (e.g. dep/anx)

52
Q

What are some -ve prognostic factors (6) in giving up alc/illicit drug use

A

Ambivalent to change
Cognitive impairment

Unstable accom/homeless
Unemployed

Repeated failures
Primacy

53
Q

What are the 4 principles of motivational interviewing

A

Focus - on habits want to change
Engage - estab relationship
Evoking - belief/motivation to change
Planning - practical steps to change

54
Q

Describe the Bio (3) - Psycho (6) - Social (3) management of Alcohol Misuse

A

Bio:
Chlordiazepoxide / Disulfiram (deterrent) / Acomprosate

Psycho:
AA / Drug+Alc services
Indiv Counselling / Motiv Interviewing
CBT / Self-Help

Social:
Housing support
Financial/employment support
Social services / child care

55
Q

What drugs are available for opiate dependance (3 + 2)

A

Detox - Sx relief of withdrawals:
Lofexidine
Loperamide / Metoclopramide (anti-emetics)

Substitute - long-term as alternative:
Methadone
Buprenorphine

Psychiatry (11 decks)

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